From the Guidelines
Ketorolac should be used with caution in patients with asthma due to the risk of bronchospasm. According to the study 1, asthma can be exacerbated by certain drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), which includes ketorolac. The mechanism behind this reaction involves the inhibition of cyclooxygenase enzymes, which shifts arachidonic acid metabolism toward the lipoxygenase pathway, increasing production of leukotrienes that can trigger bronchospasm. Some key points to consider when using ketorolac in patients with asthma include:
- If a patient has a known history of NSAID-induced asthma exacerbations, ketorolac is contraindicated.
- For patients with stable asthma and no history of NSAID sensitivity, ketorolac may be used with careful monitoring for respiratory symptoms.
- The lowest effective dose of ketorolac should be used, typically 10mg orally or 15-30mg IM/IV.
- Patients should be monitored closely for wheezing or shortness of breath, and have rescue medications readily available.
- Alternative pain medications like acetaminophen or certain opioids may be safer options for asthmatic patients with known NSAID sensitivity. It's also important to note that aspirin-sensitive asthma is frequently associated with a genetic sequence variation and is relatively common in Eastern Europe and Japan, as mentioned in the study 1.
From the FDA Drug Label
Ketorolac tromethamine should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients Patients with asthma may have aspirin-sensitive asthma The use of aspirin in patients with aspirin-sensitive asthma has been associated with severe bronchospasm which can be fatal Since cross reactivity, including bronchospasm, between aspirin and other non-steroidal anti-inflammatory drugs has been reported in such aspirin-sensitive patients, ketorolac tromethamine should not be administered to patients with this form of aspirin sensitivity and should be used with caution in patients with preexisting asthma
Ketorolac is not safe to use in patients with asthma, especially those with aspirin-sensitive asthma, due to the risk of severe bronchospasm and anaphylactic-like reactions 2, 2.
- Contraindication: Ketorolac tromethamine is contraindicated in patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
- Preexisting Asthma: Patients with preexisting asthma should be used with caution when taking ketorolac tromethamine.
From the Research
Safety of Ketorolac in Asthma Patients
- Ketorolac is a Nonsteroidal Anti-Inflammatory Drug (NSAID) that can precipitate bronchospastic- and anaphylactic-type life-threatening reactions in some patients, including those with asthma 3.
- The use of ketorolac is contraindicated in patients with a history of aspirin and NSAID intolerance, asthma, rhinitis, and nasal polyps 3.
- When administering ketorolac to asthmatics, it should be done with extreme caution and monitoring, especially when the intramuscular preparation is used 3.
Alternative Treatment Options
- Celecoxib, a highly selective COX-2 inhibitor, has been shown to be safe in patients with aspirin-induced asthma 4.
- Inhaled corticosteroids are the preferred monotherapy for patients with persistent asthma, and have been shown to be more effective than anti-leukotrienes in preventing exacerbations and improving lung function 5.
Management of Asthma Exacerbations
- Acute asthma exacerbations can be triggered by various factors, including NSAIDs like ketorolac 6.
- The management of asthma exacerbations involves the use of short-acting β2-agonists, inhaled corticosteroids, and other controller medications, as well as the avoidance of aggravating environmental factors 7, 6.